Suspected fetal macrosomia: Guidelines vs. reality

Article Outline

• Objective
• Study design
• Results
• Conclusion
• Copyright

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Objective 

Suspected macrosomia is a common obstetric condition, which is still considered challenging. We aimed to evaluate the effect of our management policy in a suspected macrosomic fetus on pregnancy outcome. Furthermore, our prediction ability of excessive fetal weights using clinical and ultrasonographic estimations was evaluated.

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Study design 

In this prospective observational study we followed the management of 145 term women who were admitted with a documented diagnosis of suspected fetal macrosomia, as well as women with fetal weight estimation of >4000 g. The diagnosis was made by an obstetrician, based on his clinical judgment and/or ultrasound results. The comparison group (n=5943) consisted of all other women who gave birth during the data collection period. These data was received from our computerized perinatal database.

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Results 

Induction of labor and cesarean delivery rates in the macrosomic pregnancies (birth weight >4000 g) of the study group were significantly higher when compared with the macrosomic pregnancies of the comparison group (42.1% vs. 13.6%, P < .001 and 57.1% vs. 16.7%, respectively). When comparing the non macrosomic (birth weight <4000 g) to the macrosomic pregnancies of the study group no significant difference was demonstrated regarding maternal or infant complications. The sensitivity, specificity and positive predictive value of the methods used for detecting macrosomia were 21.6%, 98.6% and 43.5% respectively.

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Conclusion 

Our active management of suspected macrosomic pregnancies increased induction of labor and cesarean delivery rates without improving maternal or fetal outcome. Our ability to predict macrosomia is poor.